Clinical Decisionmaking

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Under new government guidelines, normal systolic blood pressure (BP), which reflects pressure on the artery walls when the heart contracts, is less than 120 mm Hg systolic. Normal diastolic blood pressure, which represents pressure on the artery walls between beats, is less than 80 mm Hg. Yet, a new study found that nearly one-third of older Americans, whose systolic blood pressure was 140 mm Hg or higher, didn't think they had high blood pressure. Their limited awareness of the dangers of systolic hypertension was a greater barrier to BP control than medication costs. Also, many older Americans preferred to integrate traditional approaches to BP control, such as medication and lifestyle changes, with complementary and alternative strategies.

To improve blood pressure control among older Americans, clinicians and health educators need to increase awareness and understanding about the
dangers of systolic hypertension. Also, health care workers need to use a more holistic approach to managing high blood pressure (HBP), according to the researchers who conducted the study. Their work was supported in part by the Agency for Healthcare Research and Quality (HS10871). Lead author, Brent M. Egan, M.D., of the Medical University of South Carolina, and his colleagues conducted telephone interviews with a nationally representative sample of 1,503 adults 50 years of age or older to determine their hypertension awareness, knowledge, attitudes, and health behaviors.

Only 27 percent of those surveyed acknowledged that the top number (systolic BP) can determine the presence of HBP. Of those who reported systolic values of more than 140 mm Hg, 30 percent stated they did not have HBP, including 36 percent in the 140 to 150 mm Hg range, 11 percent in the 160 to 179 mm Hg range, and 18 percent in the 180 mm Hg or more range. Among those who acknowledged current HBP, 80 percent reported taking medications "precisely as prescribed." Cost was a major factor for only 4 percent of the remaining 20 percent who no longer took medications or took fewer than prescribed. When asked what HBP information was most important, 34 percent reported alternative therapies and 28 percent reported prevention strategies.